Human Vaccines & Immunotherapeutics

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Funding vaccines for emerging infectious diseases

Gary Wong & Xiangguo Qiu

To cite this article: Gary Wong & Xiangguo Qiu (2018) Funding vaccines for emerging
infectious diseases, Human Vaccines & Immunotherapeutics, 14:7, 1760-1762, DOI:
10.1080/21645515.2017.1412024

To link to this article: https://doi.org/10.1080/21645515.2017.1412024

Published online: 16 Jan 2018.

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HUMAN VACCINES & IMMUNOTHERAPEUTICS
2018, VOL. 14, NO. 7, 1760–1762
https://doi.org/10.1080/21645515.2017.1412024

COMMENTARY

Funding vaccines for emerging infectious diseases

Gary Wonga and Xiangguo Qiub,c
a
Guangdong Key Laboratory for Diagnosis and Treatment of Emerging Infectious Diseases, Shenzhen Key Laboratory of Pathogen and Immunity,
Shenzhen Third People’s Hospital, Shenzhen, China; bSpecial Pathogens Program, National Microbiology Laboratory, Winnipeg, Canada; cDepartment
of Medical Microbiology, University of Manitoba, Winnipeg, Canada

ABSTRACT ARTICLE HISTORY

Immunization has played a large role in substantially reducing the infected and death tolls from infectious Received 1 November 2017
diseases. In the case of emerging diseases, the identity of the pathogen responsible, as well as the time Accepted 24 November 2017
and location for the next outbreak, cannot be accurately predicted using current means. Coupled with KEYWORDS
disjointed efforts towards the development of vaccines and a lack of funds and desire to advance Ebola; influenza; funding;
promising products against known emerging pathogens to clinical trials, there has been a shortage of MERS; SARS; vaccine;
approved products ready for emergency use. Recent outbreaks have exposed these weaknesses, and the vaccinology; Zika
Coalition for Epidemic Preparedness Innovations (CEPI) was created in 2016 to address these issues. In this
commentary, we discuss the establishment of such a global vaccine fund, and provide some additional
points to consider for stimulating further discussion on this comprehensive, ambitious initiative.

Emerging infectious diseases are considered as such if they
appear for the first time in a population or if they are rapidly
increasing in geographic range or the incidence of cases (i.e. an
outbreak). Unlike other pathogens, emerging infectious dis-
eases pose a unique threat in that health authorities will often
have little to no prior experience with the prevention and con-
trol of these pathogens. From the beginning of the 21st century
to the present, the world has experienced several high-profile
outbreaks of emerging infectious disease caused by novel or
obscure, neglected pathogens: SARS-CoV in 2003–04 originat-
ing in China, H1N1 “swine flu” in 2009 from Mexico, MERS-
CoV since 2012 originating in Saudi Arabia, Ebola virus
(EBOV) from 2013–16 originating in Guinea, and Zika virus
(ZIKV) during 2015–16 originating in Brazil. In each instance,
it was not possible to predict the time, location or identity of
the causative pathogen beforehand. Indeed, prior to the EBOV
and ZIKV outbreaks in 2013 and 2015, respectively, both were
considered neglected tropical pathogens. Both SARS-CoV and
MERS-CoV were novel pathogens reported for the first time,
and emerging influenza viruses were typically novel pathogens
derived from genetic evolution and reassortment. Other factors
such as urbanization have led to increased contact between
human populations and wild animals potentially carrying novel
zoonotic diseases. Furthermore, factors such as globalization
have resulted in the increased movement of people (and thus
pathogens) across national borders, and climate change may
facilitate the spread and transmission of certain pathogens as
well as changes in the geographical distribution of reservoir
hosts and/or vectors.
Vaccination is currently the best defence we have against
these unpredictable outbreaks of emerging disease, and the
complete process for bringing a vaccine from the research
laboratory to the population in need can be described in
four stages.1 Stage 1 consists of the discovery phase, in which
vaccine candidates are developed and characterized in animal
models; Stage 2 is the development and licensure phase, in
which the product at hand is advanced through clinical tri-
als; Stage 3 is the manufacturing phase, in which there is
GMP-level production of the vaccine on a large scale; and
Stage 4 is the delivery and stockpiling phase, in which the
manufactured product is delivered to populations residing at
the most at-risk locations, as well as accumulated and stored
in various locations in preparation for use during an
outbreak.
With the development of a new vaccine requiring a capital
investment of $500 million to $1 billion dollars2 and typically a
10 year minimum to advance the vaccine from bench to bed-
side, there is a lack of incentive from agencies to fund research
into and develop vaccines against obscure pathogens that may
or may not cause outbreaks in humans; especially with so
many other pathogens that already affect millions still lacking a
vaccine or having sub-optimal vaccines such as the HIV or hep-
atitis B viruses, and the influenza virus, respectively. As noted
previously, fragmented vaccine-development efforts, and unco-
ordinated government funding (i.e. without a clear plan that
addresses global threats internationally) have resulted in too
many missed opportunities to efficiently bring an efficacious
vaccine to market before an epidemic strikes.3 A recent exam-
ple is the 2013–16 EBOV outbreak in West Africa, in which
two promising candidates, namely the adenovirus-vectored
(Ad5-GP)4 and the vesicular stomatitis virus-vectored
(VSVDG/EBOVGP) 5 vaccines had been tested in nonhuman

CONTACT Xiangguo Qiu xiangguo.qiu@phac-aspc.gc.ca Special Pathogens Program, Public Health Agency of Canada. 1015 Arlington Street, Winnipeg, MB,
R3E 3R2, Canada.
© 2018 Taylor & Francis

primates in 2003 and 2005, respectively. However, only Ad5-
GP was subsequently evaluated in Phase I clinical trials6 during
2010 and was not investigated further, despite positive immu-
nogenicity and safety data.
It was clear that improvements needed to be made to the
current system of vaccine development, and several world-
renowned experts have proposed the establishment of a global
vaccine-development fund to “provide the resources and
momentum to carry vaccines from their conception in aca-
demic and government laboratories and small biotechnology
firms to development and licensure by the industry”.7 In
response, the Bill and Melinda Gates Foundation, the World
Economic Forum, Wellcome Trust and the governments of
Norway and India co-founded the Coalition for Epidemic Pre-
paredness Innovations (CEPI) in 2016, which aims to “stimu-
late, finance and coordinate the development of vaccines
against epidemic diseases, especially in cases in which market
incentives alone are insufficient”.3 Other entities, such as the
governments of Germany and Japan, have since joined as
investors. As a funder, CEPI plans to bridge the gaps in devel-
opment and provision by funding promising vaccines with a
five-year goal of accelerating four potential candidates against
2–3 high priority pathogens to the stage where safety and effi-
cacy will be demonstrated, such that the vaccines will be ready
for Phase III testing (or potentially deployment) in the event of
an outbreak. As a facilitator, CEPI plans to collaborate with the
industry, regulators and other relevant organizations to
improve regulatory preparedness, as well as ensure that vac-
cines with proven safety and efficacy are licensed and reach the
populations who need them the most.8 CEPI will initially focus
on a list of blueprint priority diseases that the World Health
Organization (WHO) has revealed in January 2017,9 which
currently consists of Lassa Fever, Crimean Congo Hemorrhagic
Fever, Ebola and Marburg virus disease, MERS, SARS, Nipah
and other henipavirus diseases, Rift Valley Fever, Severe Fever
with Thrombocytopenia Syndrome and Zika Fever. The causa-
tive pathogens behind these diseases are all known threats to
public health.
There are some points to consider when implementing such
an ambitious, end-to-end vaccine initiative. First, funding for
vaccine research should not be isolated from other areas of out-
break control, such as surveillance efforts. Recent studies have
indicated that highly pathogenic H5N8 has spread from Asia
into Europe and North America,10 and in China, a “hotbed” for
the emergence of novel influenza viruses, findings indicate that
H5N6 has become the dominant circulating subtype in south-
ern China since at least 2015, causing several human deaths.11
Other outbreak viruses may also be prone to mutations and as
such stockpiled vaccines may need to be updated speedily and
effectively in case of anticipated failure. Second, the exact geo-
graphical locations in which known viruses circulate may not
always be accurate. For instance, EBOV, thought to be mainly
in Central Africa, unexpectedly emerged in Western Africa in
2013. Therefore, not only is stockpiling important, but logistics
need to be resolved such a way that existing vaccine stocks can
be moved at short notice to contain the number of cases in out-
break areas. Third, each emerging pathogen poses its unique
differences and challenges, and the current stage of vaccine
development varies widely between each disease. For instance,
HUMAN VACCINES & IMMUNOTHERAPEUTICS 1761
with EBOV the main bottleneck was the lack of support to
advance promising products through the clinical pipeline, but
there are not as many choices for experimental vaccines against
other related viruses, such as BDBV and TAFV, due in part to
the lack of a small animal model to screen antivirals in an effi-
cient manner. Similarly, the main bottleneck for SARS-CoV
and MERS-CoV vaccine development is the lack of a widely
available, susceptible/lethal small animal model. Therefore,
funding efforts may need to focus on different stages of devel-
opment depending on the pathogen in question. Fourth, vac-
cine delivery should also be accompanied by outreach efforts,
such as education of the local populace on general information
regarding infectious diseases and existing countermeasures, in
order to promote wider acceptance for immunization during
non-outbreak times. Finally, there is always the possibility of a
completely novel, previously undiscovered pathogen that
emerges to wreak havoc. Rather than disrupting ongoing vac-
cine research efforts by redirecting existing funds or attempting
to fund-raise during an emergency, it may be better to set aside
“rainy day” funds that can be unlocked for immediate use in
this scenario.
The coordination of efforts to provide much-needed
funding to develop, accelerate and advance promising vac-
cine candidates represents a strategic investment that will
save untold numbers of lives and reduce excessive spending
in the future. If those in charge of implementing the plan
are flexible, receptive, and adaptable to ever-changing cir-
cumstances, with solid contingency plans in place, this ini-
tiative will undoubtedly be a positive contribution to the
global war on infectious diseases.
Disclosure of potential conflicts of interest
No potential conflicts of interest were disclosed.
Funding
This work is supported by the National Key Research and Development
Program of China (2016YFE0205800), the National Key Program for
Infectious Disease of China (2016ZX10004222), the Public Health Agency
of Canada, partially supported by grants from the National Institutes of
Health (U19AI109762-1) and Canadian Institutes of Health Research
(IER–143487), the Sanming Project of Medicine in Shenzhen
(ZDSYS201504301534057), the Shenzhen Science and Technology
Research and Development Project (JCYJ20160427151920801), and the
National Natural Science Foundation of China International Cooperation
and Exchange Program (816110193). The authors declare no competing
financial interests.
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